Download PDF
CC BY-NC-ND 4.0 · Ann Natl Acad Med Sci 2016; 52(04): 222-231
DOI: 10.1055/s-0040-1712738
Original Article

Experimental and Clinical Evidence Based Rationality of Incorporation of Deep Fascia in Tissue Transfer for Reconstructive Surgery

V. Bhattacharya
Former HOD, Plastic Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
› Author Affiliations
› Further Information
  PDF Download Permissions and Reprints

ABSTRACT

Intense clinical research since 1984 through 93 parameters has unveiled the rationality of reconstructive procedures with several new concepts and innovative techniques of various compositions. Such extensive work has been done totally in our country popularizing the techniques amongst the plastic surgeons of the world. This presentation deals with the tissue constituents and vascular network of the deep fascia. This sustained research was conducted at inter-departmental, interfaculty and interinstitutional levels.

Intense clinical research since 1984 through 93 parameters has unveiled the rationality of reconstructive procedures with several new concepts and innovative techniques of various compositions. Such extensive work has been done totally in our country popularizing the techniques amongst the plastic surgeons of the world. This presentation deals with the tissue constituents and vascular network of the deep fascia. This sustained research was conducted at inter-departmental, interfaculty and interinstitutional levels.

Histology of deep fascia showed rich subfascial and suprafascial arterioles and capillaries. Intrafascial course of the perforating vessels from the subfascial plane to the suprafascial plane was visualized. Confocal microscopic analysis of fluorecenised deep fascia under 40X magnification showed longitudinally aligned collagen fibres and nuclei of multiple fibroblasts. Electron microscopic Y of deep fascia revealed (a) Elastic tissue and collagen fibres, (b) Lymphatic vessel, (c) Thin walled venule with single layer of muscle fiber, endothelial cell nucleus, Venules with multiple RBCs, mast cell with granules and capillary showing endothelium and endothelial cells.

Angiography in experimental model and patients, demonstrated longitudinally oriented vascular network in deep fascia and fasciocutaneous flap. Live microcirculation and Lymphatic circulation in the human deep fascia was demonstrated first time in the world under 150 and 600 magnifications.

Keywords

Deep Fascia - reconstructive Surgery - Microcirculation

COL. SANGHAM LAL MEMORIAL ORATION delivered during NAMSCON 2016 at the All India Institute of Medical Sciences, Raipur.




Publication History

Article published online:
07 May 2020

© .

Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India

 

  • REFERENCES

  • 1 McCarthy (1990). Plastic Surgery. General Principles. Vol. 1, Philadelphia: WB Saunders Company, 275-377.
  • 2 Ponten B (1981). The fasciocutaneous flap: its use in soft tissue defects of lower leg. BJPS 34: 215-220.
  • 3 Taylor GI, Palmer JH (1987). The vascular territories (angiosomes) of the body: Experimental study and clinical applications. BJPS 40: 113-141.
  • 4 Bhattacharya V, Reddy GR, Goyal S, Kumar U (2007). Skeletonised retrograde distal perforator island fasciocutaneous flaps for leg and foot defects. J Plast Reconstr Aesthet Surg 60: 892-897.
  • 5 Cormack GG, Lamberty BGH. The fasciocutaneous system of vessels. The Arterial Anatomy of Skin Flap. Churchill Livingstone, 1986.
  • 6 Bhattacharya V, Barooah PS, Nag TC , et al. (2010). Detail microscopic analysis of deep fascia of lower limb and its surgical implication. IJPS 43: 135-140.
  • 7 Bhattacharya V, Goyal S (2006). A dye study in fresh cadavers to outline retrograde flaps of the lower limb and to examine clinical implications. European Journal of Plastic Surgery 28:458-463.
  • 8 Bhattachatya V, Goyal S, Jain P, Singh NS (2006). Angiographic evaluation of fasciocutaneous flaps. Int Surgery 91: 326-331.
  • 9 Bhattacharya V, Agrawal NK, Chaudhury GR, et al. (2012). CT Angiographic evaluation of perforators in the lower limb and their reconstructive implication. IJPS 45: 494-497.
  • 10 Bhattacharya V, Deshpande SB, Watts RK , et al. (2005). Measurement of perfusion pressure of perforators and its correlation with their internal diameter. BJPS 58:759-764.
  • 11 Bhattacharya V, Watts RK, Reddy GR (2005). Live demonstration of microcirculation in the deep fascia and its implication. Plast Reconstr Surg 115: 458-463.
  • 12 Bhattacharya V, Choudhuri GR, Mishra B, Kumar U (2011). Demonstration of live lymphatic circulation in the deep fascia and its implication. European Journal of Plastic Surgery 34(2): 99-102.